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From OW! to WOW! Demystifying Painful Intercourse

by

Heather Corinna

People often write into Scarleteen reporting that, for them or their partners, vaginal entry -- most typically with penis-in-vagina intercourse or manual vaginal sex ("fingering"), and usually (but not always) with male partners -- is painful, uncomfortable, or unfulfilling. Sadly, many young people report having painful intercourse or other vaginal sex again and again, many without even saying anything about it to their partners or looking into the why of their pain.

In fact, plenty of people of all ages simply assume intercourse is going to be, or has to be, painful or uncomfortable -- some for the first few times, others that it simply always is to some degree. There tends to be more expectation that vaginal entry will be painful than pleasurable, even though vaginal pain is often completely avoidable, and most of the time, there's nothing normal about pain. Instead, it's usually a signal that something is wrong, whether that's about a health condition or about people just going about sexual activities in a way that's causing pain.

Whatever sort of vaginal entry we're talking about -- with fingers, a penis or a dildo, with partners of any gender -- it not only doesn't have to be painful, it really shouldn't be, and for most people experiencing pain during vaginal sex, there are solutions. And any kind of sex shouldn't be about a lack of pain, but about the presence of pleasure.

Are you (or is your partner) experiencing vaginal pain during sex? Then read on while we look at the most common culprits and talk about how to identify, address, process and be rid of them, and help make vaginal stimulus more likely to be a "Wow," not an "Ow."

1. Are those annual sexual health exams up-to-date? Both pap smears and bimanual exams are recommended to be started at age 21, BUT if there's pain involved that's the very first place to start. And let's not leave out the importance of a full STI screening.

If you're having more than one partner in a year -- yep, even if you're using latex barriers for manual sex, oral sex, vaginal and/or anal sex -- you need those STI screenings even more often.

Sometimes pain with intercourse or other kinds of sex is due to an infection or other medical issues, and will need diagnosis by a doctor -- and it may take more than one: misdiagnosis of vaginal or vulval pain is unfortunately common -- followed by medical treatment. Even if you're doing everything else we'll address in this piece, you may still have pain or discomfort if a medical, rather than behavioral, issue is what is causing your pain.

Been having unprotected sex? Having pain during intercourse? Unexplained bleeding during and/or after? While Chlamydia can often be asymptomatic, these are also very common symptoms. Chlamydia rates in young women are incredibly high, and chances are good that part of why is because male partners saying they have been having STI screenings just plain haven't, and young women aren't insisting on safer sex. Many more women here report their male partners have been screened here than is statistically realistic. If you haven't had a copy of your partner's recent screening results in your hands, assume they have NOT been screened, and insist on using all aspects of safer sex with those partners. If you haven't been, even without vaginal pain or bleeding, get in and get your own screenings NOW, and insist that your partner does the same, even if you intend to wise up and practice safer sex from now on.

Painful vaginal entry or intercourse can be due to certain genital infections, as well as because of reproductive health conditions like vaginismus, vulvar vestibulitis, lichen sclerosus, endometriosis, pelvic inflammatory disease (which usually arises from unidentified and/or untreated STIs) or an imperforate or particularly inflexible corona (hymen). So, before you look for any other culprits, start in the office of your healthcare pro who is well-educated about pain conditions: that's important to find out if the problem is physical, and if so to get treatment AND to safeguard your sexual and general health.

Once that is taken care of, and if either no medical culprits are found, or they are, and are treated but you're still having discomfort or pain, look further.

2. Are you highly aroused well BEFORE any sort of vaginal entry begins?

For real?(And did you really go tend to that exam first? Seriously, start with that.)

If you answered yes without even a thought (or an enjoyable, wistful sigh), and you haven't been sexually active for a long time or actively masturbating on your own for a good while, you may not be or even know when you are aroused. Liking our partner, even being crazy in love with them, isn't the same thing as big-time sexual arousal.

If you're a young, healthy person without any medical conditions which can alter how your sexual response system system works, when you're very aroused, generally, you will feel a bit flushed. Your heart rate will be a bit quicker, your body may feel tingly, your muscles alert but relaxed. You may be breathing more quickly. Your vagina will usually naturally lubricate, sometimes profoundly (though at some times in your monthly cycle, that may be more or less) so that you feel "wet." Your genitals and whole body will tend to feel more and more sensitive the more highly aroused you become; your clitoris will enlarge slightly, your vaginal opening will loosen, your breasts may also swell. You will feel a very strong desire to be sexually engaged in some way, be it with a partner or by yourself, usually more so then when sexual activity just started.

What sorts of things might inhibit (keep you from) full arousal?

an emotionally, sexually or physically abusive partner or a partner who pressures for sex

worries about embarrassing oneself, doing sex "wrong" or really letting go in front of a partner

certain prescription (like some antidepressants) or recreational drugs or alcohol

poor general health, sedentary lifestyle or poor nutrition

body or self-image problems

anticipating pain; feeling scared or nervous

orientation questioning or strong doubts

ethical conflicts about being sexually active

being with a partner you really don't want to be with, or who you don't feel safe with

feeling like you might get caught (having limited privacy) or being in a rush or hurry

the old wham-bam-thank-you-ma'am: in other words, jumping (or being pushed) right into vaginal entry without any sort of fanfare, without foreplay, etc.

entering into certain sexual activities before you really want to or feel ready

feeling like sex is a performance, or a way to prove your worth to a partner

And in that same vein:

3. Do you really WANT to be having intercourse/manual sex or any sort of sex? That might sound silly, but it's important to consider every time you have sex: do you want to have intercourse or other vaginal sex for YOUR pleasure and satisfaction as much as your partners? Do you find yourself attempting intercourse or manual sex with a partner when you suspect or know you aren't aroused or interested, maybe because you know it'll get them to stop nagging you or placate them? If so, in a word, knock it off. You truly don't want to get into that habit or set that precedent.

Say what? "Loose" is BETTER?!?
When not sexually aroused, the vaginal opening and canal are more constricted, "tighter," than during arousal. During arousal, the vagina self-lubricates, engorges with blood (which causes the clitoris and clitoral sponge to grow in size not unlike the male penis does), hormones secreted in the body help to relax the canal and opening of the vagina, and the back of the vagina "tents," expanding in both width and depth. And the vagina isn't static: so "looseness" or 'tightness" change in the day-to-day. There aren't "loose" vaginas and "tight" vaginas as a whole.

So, when people go on about a "tight" vagina being ideal, what they're really saying -- even if they don't realize it -- is that an unaroused, uncomfortable person -- usually a woman -- is ideal. I think we can all agree there's nothing ideal about being uncomfortable and not into sex during sex. Not only is it far from ideal for the person feeling that way, it's not ideal for partners, either. With arousal, when the vagina is engaged, that muscle contracts actively around what is inside it; a penis, toy or fingers can move much more freely and feel more intense sensations than inside a vagina that is unaroused, dryer, and constricted by the lack of relaxation and arousal so as to not even allow for deeper entry.

Of course, for a well-adjusted person interested and invested in sex being a mutually pleasurable experience, there's nothing at all desirable about an unaroused, uncomfortable partner.

Is your partner attempting intercourse when he or she doesn't feel aroused? Probably not, since when any kind of sex occurs, it's very unusual for both people to be engaging in it when both don't want to be or don't feel excited. Good for anyone only pursuing sex when they're excited and aroused and comfortable: sex out of nothing but obligation tends to be really detrimental physically, sexually, emotionally and to a healthy relationship. But the same standard should be held for all partners, and be one you hold for yourself.

Certainly, especially in long-term relationships, we'll sometimes find ourselves in the position where one of us is in the mood, but the other just isn't so much, or is only halfway there. When that's so, we have plenty of options. We or our partners can always masturbate. We also always have the option to engage in sexual activities which we do feel up to, or are aroused enough to enjoy, many of which don't require our genitals to be all-ready to go, and which we probably enjoy even at moderate-level arousal just because they please our partners. Sometimes, we are in a headspace to enjoy bringing a partner pleasure (and vice-versa), even if we're not in the mood (maybe we're too tired, maybe we already got off and feel finished, maybe we don't have time on a given day for the spaciness orgasm can bring, maybe we can just feel our bodies aren't going to go there right then) to get off ourselves. Engaging in manual, oral sex, phone sex or some level of mutual masturbation with a partner, for instance, are these kinds of options.

Once you start a sexual relationship, that also doesn't mean your partner (or you, for that matter) has an all-access-pass to sex whenever, wherever, or however they want it with you. That's what masturbation is for: that's the only 24/7 pass to sex at anytime any of us gets to have. Even in a long-term relationship, sex is a request, a possibility, and in a healthy, mutually respectful partnership, only when both partners are aroused -- or interested in becoming aroused -- and truly interested in sex.

In many cultures, ours certainly included, penis-in-vagina intercourse is set up as the default from of sex, as the "real" sex, as the sex that all other sex acts should lead up to, as the sex everyone should be having most often. But one has to remember that those ideas cemented during times when the comfort, pleasure and autonomy of women (identified at the time as those with vaginas) was in no way a priority; when women engaging in sex was widely viewed as a "duty" to one's partner, whether or not the woman in question was experiencing pleasure, or even basic comfort; when women weren't even recognized as having a sexuality of our own. Sadly, marital rape is still considered okay by a lot of people, based in part on those ideas: that women's bodies become owned, depersonalized or subservient property in sexual relationships. Up until fairly recently, pervasive myths were spread that women who couldn't reach orgasm via intercourse weren't "real" women, and those myths still continued -- albeit slightly less prevalently -- even when more study was done on female anatomy to understand that often, our own physiology often prevents orgasm or physical pleasure from vaginal intercourse alone. Of course, the notion that heterocourse is the default sex, the "real" sex is also based in heterosexism and homophobia as well as sexism.

You may find your older siblings, aunts or uncles, parents or even your peers give you the message that you are somehow obligated to have intercourse or any other form of sex with a partner whenever they want it, but you've got to understand that anyone sending you that message is just plain wrong; is voicing a message that is harmful, painful and detrimental. Plenty of people don't question those beliefs because they're so rooted in history and some traditions they somehow seem normal, fair or sound (some people who don't question them don't because they benefit them, even if they harm others). But they aren't: not if mutually respectful and caring partnership is what you're after, and not if women's minds, hearts and bodies are being treated with respect, love and care.

4. Are you communicating with your partner, and is he or she responding to what you're communicating?

In other words, when you say, go slow, not so deep yet, or grab more of that lubricant, or ow, I think I want more oral sex first, or let's try this position instead, or can you rub my clitoris while you do that ... are they both listening AND following your lead? (Remember, for a partner to do that, you've got to speak up in the first place: body language can give some things away, especially when we're really familiar with a partner and their physical cues, but verbalizing this stuff clearly often does that better and is really vital when either a partner or sex in general is new to either or both people.)

Faking orgasm or pleasure, for the record, is a complete barrier to satisfying sex and good sexual partnership. If, via faking, you're lying to a partner about what feels good and doesn't, he or she isn't very likely to be able to find out what WILL feel good. And keeping at it when you're in pain makes it much more likely that you'll continue to have pain every time you engage in the same activity. Vaginal muscles and the rest of our bodies actually anticipate the pain with cues from our brains, and that can keep us from full arousal and cause the vagina to constrict upon itself, rather than opening up.

Dear Person with a Penis,

How can you help out here? Pretty easily. If you have a partner having vaginal pain and are concerned about a partner's pleasure as much as yours to read something like this, you're already halfway there. Whoohoo!

- Make clear to your partner, from the onset of your sexual partnership, that they should always feel free to let you know when thay're feeling any pain or discomfort, even if you appear to be enjoying yourself, and that you have exactly zero problem halting or changing the action so that they, too, feels good. You can also make clear that you only want to be having sex together at times BOTH of you want to, not just when one of you does. (P.S. If you don't actually feel that way or can't deal with that? Then you just aren't ready for sound sexual partnership yet. To treat a partner like a whole human being, not an object or sex toy, those are entry-level requirements.)

Are you having pain during intercourse? While it's way more common for people with vaginas to experience pain, sometimes people with penises might, too. Similar rules apply to you in getting to the bottom of it. Start with your sexual healthcare provider to rule out infections or other health conditions. If nothing is amiss, it's probably about needing more lubricant or experimenting with positions to find the ones that feel good instead of owie.

- Ask questions during sex. We're not talking about anything complicated: "How does this feel?" and "Is that comfortable for you?" and "Need more lube?" and "What position feels best for you?" and "Want me to go deeper/faster or not?"

- Don't bang away with your penis or fingers if a partner's vagina appears to be putting up resistance or they're clearly not enjoying themselves. Instead, go back a step or two: if inserting your penis is problematic or is causing your partner discomfort, go back to the clitoris or whatever other body parts they get turned on by for a while, maybe lube up a single finger and massage the vaginal opening until the vagina itself almost seems to "suck" that finger in readily. Think baby steps. Think about the sort of TLC, for instance, your testicles or your anus need.

- Let your partner initiate sex just as much as you do.

- Don't rush. Period. It's understandable to want to hurry due to short or unpredictable erection times, or because it just feels so intense, but other sex when erections don't hang around, or additional sexual activity for your partner with hands or mouths if you reach orgasm yourself quickly is always, always better than pain for your partner.

- Remember that the vaginal canal not only isn't where all of sexuality and pleasure lies, but that for most people with that anatomy, it's secondary to other body parts. Paying attention to a partner's whole body and whole vulva -- not just the vagina -- is the real deal (and, in fact, equally encouraging your partner to pay attention to YOUR whole body and the whole of YOUR genitals --the penis, but also the testes, perineum and anus, pressure points around the pelvis -- also will enhance YOUR sex life and the level of your pleasure, too!).

- If your friends start riffing off on a bunch of sexist sex myths (like a "tight" vagina being ideal, or intercourse being obligatory), find ways to pass on more accurate, healthy information.

P.S. This isn't being said to you and not women because we think boys are jerks or stupid. Rather, this is being said to you because you don't have a vag yourself, and unless you've engaged in receptive anal sex -- which isn't identical, but is similar -- you're usually not going to have any real idea what this can feel like. Too, social and cultural standards in terms of gender roles and heterosexual dynamics often come into play with this stuff, so gender isn't a nonissue.

5. Is your partner being observant and patient enough to really pay attention to the contours of your body, inside and out? Are you communicating clearly with them to help out? For instance, the vaginal canal is curved, not straight, so sticking stiff, pointed fingers in there isn't likely to be pleasant, nor is approaching intercourse at an angle in which the penis or toy is poking the walls of the vagina, rather than following its more curvilinear contours. Make sure you're both taking the time to adjust positions or postures so that they are in harmony with your anatomy. Don't assume, even if your partner has had sex partners with a vagina before, that they know about your body or bodies as a whole. You may need to show your partner what feels good to you, speak up more to be clear about what you like and don't, or have your partner take more time to get to know your body gradually before certain kinds of sex.

6. Are you using lubricant as needed? Lube can't replace arousal, mind you: it can't loosen the vaginal canal and opening the way that arousal can. But when you are already there, and things don't feel very slippery, it can be a big help. When using condoms and barriers, it's essential, not just to keep the barrier from tearing, but because often our own natural lube isn't enough when a barrier is added. Too, if you're also using hormonal contraceptives, often one of the side effects is an increase in vaginal dryness. During certain times of the fertility cycle as well (for those who are not using the pill, the patch or other hormonal methods), cervical mucus is thicker, which can make things more sticky and less slippery. Friction is part of what makes any kind of vaginal stimulus -- like intercourse or manual sex -- feel good, but too much friction causes discomfort. Using plenty of latex-safe, water-based lube helps you strike the right balance.

7. Have you had previous sexual trauma (like any form of rape, molestation or other sexual abuse)? Have you had pain during vaginal entry before, or previous partners who were too rough, inconsiderate or who you felt fearful with?

These previous experiences can result in current pain from intercourse or manual sex, because, in essence, our bodies remember the pain we've felt before and anticipate it by locking up and inhibiting arousal. If you suspect this is an issue, you can deal with that via counseling, and/or by letting your partner know about these experiences, and making sure you're both taking as much time as you need to introduce vaginal entry -- that can be weeks, months, even years. Whatever pace works for you -- makes you feel safe and relaxed over time so your body can -- is absolutely fine. So many people have some form of sexual abuse or assault in their history, and any partner who has sex partners who are survivors needs to be willing to work with those issues and the extra time it sometimes takes survivors to really get comfortable.

Sexual shaming is also a form of sexual trauma. If you have been raised with the strong message that wanting or having sex, or being aroused is shameful, dirty or makes you a bad person, that can make full arousal and pleasurable, comfortable sexual activity difficult.

Not as simple as 1 - 2 - 3 , but it's a start.

One: Not sure if you're really highly aroused or if that's an issue? Try having an orgasm BEFORE attempting sexual intercourse or manual sex. In other words, engage in other sexual activities with your partner which bring you to orgasm first, then right afterward, try vaginal entry. If your answer to this is:a) You haven't had an orgasm yet or found out how to reach orgasm: then invest some time and energy, solo and with your partner, in finding that out well before getting to intercourse. You can even add a smaller amount of vaginal entry in that mix when exploring, via just a gentle finger or smaller toy, if you like.b) Your partner isn't willing to hold off on intercourse or spend time exploring what does feel good and does bring you pleasure and/or orgasm: ditch that partner if a couple honest talks don't change that. Seriously. That may sound harsh, but a partner uninvested or uninterested in their partner's comfort or pleasure, or putting it second, isn't willing or ready to treat you like a partner: they're treating you like an accessory for masturbation, and that just isn't healthy, respectful or good for anybody.

If you discover that orgasm before intercourse or other vaginal entry makes the pain go poofie, then it's safe to assume that you haven't been aroused enough when you've tried before. So, you can then focus more on getting you aroused, or heck, make a habit of getting to orgasm first before vaginal sex.

Two: BE VERBAL AND CLEAR when you're not feeling good. Don't fake pleasure or say something feels okay when it doesn't, and don't just hope things will improve magically on their own. Neither you nor your partner are going to be able to figure out what DOES feel good, and isn't painful, if you're not communicating freely and clearly. If you don't feel ready or able to communicate during or about sex with a partner pretty honestly yet, then it's just not wise to engage in sex with a partner until you can. Suffice it to say, if you are earnestly fearful to say anything with a partner, you're with the wrong partner, period, and you need to get out of that situation, pronto.

and Three: Respect yourself. Caring for and honoring your body (and what's it's telling you with how it feels), saying no to someone else's pleasure which is causing your injury, pain and discomfort, and expecting and insisting that any sexual partner treats you and your body with equal care and consideration are the barest bones of self-respect in a healthy sexual partnership. Plenty of things in relationship are things where we have room for compromise and negotiation. Basic self-respect isn't one of them.

One last thing: some people discover that they just do not like intercourse or any other kind of vaginal entry, with partners of any gender. People with all kinds of bodies can have that preference, but it's more common for people with vaginas to find that intercourse is just not all that for them, or even is something they just don't dig at all.

Having that preference is JUST as okay as it is for a person to discover that they just don't like experiencing anal entry, or as a person just not liking oral sex or deep-mouthed kissing (or having their ears licked, or their toes kissed, or their testicles cupped, whatever). Again, having a sexual partnership doesn't oblige or commit anyone to agree to all sex acts all the time, or even at all. You may find you need to shop a bit for a partner whose wants and needs are compatible with yours in that regard, but nearly all of us have to do that no matter what our preferences and desires are. So if NONE of this stuff works for you, if you discover that you just plain don't like vaginal entry, don't make yourself crazy over it, or become convinced there's something wrong with you. Instead, invest your energy in exploring what DOES work for you, what you DO like and with whom that all works just fine. I assure you, finding partners with whom it does is less tricky than you'd think.

the abouts:

Information on this site is provided for educational purposes. It is not meant to and cannot substitute for advice or care provided by an in-person medical professional. The information contained herein is not meant to be used to diagnose or treat a health problem or disease, or for prescribing any medication. You should always consult your own healthcare provider if you have a health problem or medical condition.